Sleep duration has been associated with nonalcoholic fatty liver disease, but its association with liver cancer remains unknown.
Material and Methods:
In the prospective Women's Health Initiative Study, 139,368 postmenopausal women reported sleep habits at baseline (1993–1998). We ascertained 175 incident liver cancer cases during an average 13.8 years of follow-up through August 2014. We used multivariable Cox proportional hazard regression models to estimate a hazard ratio (HR) and its 95% confidence interval (95% CI) for risk of liver cancer in association with nocturnal sleep duration.
Results:
Compared to women reporting 6–8 hours of sleep, the HR for liver cancer was 1.94 (95% CI 1.07–3.53) for women reporting ≥9 hours of sleep. Among the obese women, the HR associated with ≥9 hours of sleep was 3.18 (95% CI 1.84–8.60). The HR was 0.93 (95% CI 0.34–2.53) among nonobese women (p value for interaction = 0.18). Short sleep duration (≤5 hours) was not associated with liver cancer risk.
Conclusion:
Long sleep duration was associated with a moderate increase in liver cancer risk in obese postmenopausal women in the United States. Larger study is needed to confirm our observation on effect modification by adiposity status.
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References
1.
AmeratungaD, GoldinJ, HickeyM. Sleep disturbance in menopause. Intern Med J, 2012; 42:742–747.
2.
BollingerT, BollingerA, OsterH, SolbachW. Sleep, immunity, and circadian clocks: A mechanistic model. Gerontology, 2010; 56:574–580.
3.
PatelSR, ZhuX, Storfer-IsserA, et al.Sleep duration and biomarkers of inflammation. Sleep, 2009; 32:200–204.
4.
SancarA, Lindsey-BoltzLA, KangTH, ReardonJT, LeeJH, OzturkN. Circadian clock control of the cellular response to DNA damage. FEBS Lett, 2010; 584:2618–2625.
5.
KalsbeekA, laFS, FliersE. Circadian control of glucose metabolism. Mol Metab, 2014; 3:372–383.
GreeneMW. Circadian rhythms and tumor growth. Cancer Lett, 2012; 318:115–123.
8.
HuML, YehKT, LinPM, et al.Deregulated expression of circadian clock genes in gastric cancer. BMC Gastroenterol, 2014; 14:67.
9.
LinYM, ChangJH, YehKT, et al.Disturbance of circadian gene expression in hepatocellular carcinoma. Mol Carcinog, 2008; 47:925–933.
10.
OshimaT, TakenoshitaS, AkaikeM, et al.Expression of circadian genes correlates with liver metastasis and outcomes in colorectal cancer. Oncol Rep, 2011; 25:1439–1446.
11.
JiaoL, DuanZ, Sangi-HaghpeykarH, HaleL, WhiteDL, El-SeragHB. Sleep duration and incidence of colorectal cancer in postmenopausal women. Br J Cancer, 2013; 108:213–221.
12.
GuF, XiaoQ, ChuLW, et al.Sleep duration and cancer in the NIH-AARP Diet and Health Study Cohort. PLoS One, 2016; 11:e0161561.
13.
ZhangX, GiovannucciEL, WuK, et al.Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women. Sleep, 2013; 36:681–688.
14.
WongCR, NguyenMH, LimJK. Hepatocellular carcinoma in patients with non-alcoholic fatty liver disease. World J Gastroenterol, 2016; 22:8294–8303.
15.
MarengoA, RossoC, BugianesiE. Liver cancer: Connections with obesity, fatty liver, and cirrhosis. Annu Rev Med, 2016; 67:103–117.
16.
PulixiEA, TobaldiniE, BattezzatiPM, et al.Risk of obstructive sleep apnea with daytime sleepiness is associated with liver damage in non-morbidly obese patients with nonalcoholic fatty liver disease. PLoS One, 2014; 9:e96349.
17.
BernsmeierC, WeisskopfDM, PfluegerMO, et al.Sleep disruption and daytime sleepiness correlating with disease severity and insulin resistance in non-alcoholic fatty liver disease: A comparison with healthy controls. PLoS One, 2015; 10:e0143293.
18.
KimCW, YunKE, JungHS, et al.Sleep duration and quality in relation to non-alcoholic fatty liver disease in middle-aged workers and their spouses. J Hepatol, 2013; 59:351–357.
19.
WijarnpreechaK, ThongprayoonC, PanjawatananP, UngprasertP. Short sleep duration and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol, 2016; 31:1802–1807.
20.
LiuC, ZhongR, LouJ, et al.Nighttime sleep duration and risk of nonalcoholic fatty liver disease: The Dongfeng-Tongji prospective study. Ann Med, 2016; 48:468–476.
21.
ImaizumiH, TakahashiA, TanjiN, et al.The association between sleep duration and non-alcoholic fatty liver disease among Japanese men and women. Obes Facts, 2015; 8:234–242.
22.
Design of the Women's Health Initiative clinical trial and observational study. The Women's Health Initiative Study Group. Control Clin Trials, 1998; 19:61–109.
23.
CurbJD, McTiernanA, HeckbertSR, et al.Outcomes ascertainment and adjudication methods in the Women's Health Initiative. Ann Epidemiol, 2003; 13:S122–S128.
24.
LevineDW, KaplanRM, KripkeDF, BowenDJ, NaughtonMJ, ShumakerSA. Factor structure and measurement invariance of the Women's Health Initiative Insomnia Rating Scale. Psychol Assess, 2003; 15:123–136.
25.
LevineDW, KripkeDF, KaplanRM, et al.Reliability and validity of the Women's Health Initiative Insomnia Rating Scale. Psychol Assess, 2003; 15:137–148.
26.
LevineDW, DaileyME, RockhillB, TippingD, NaughtonMJ, ShumakerSA. Validation of the Women's Health Initiative Insomnia Rating Scale in a multicenter controlled clinical trial. Psychosom Med, 2005; 67:98–104.
27.
SivertsenB, SaloP, PenttiJ, KivimakiM, VahteraJ. Use of sleep medications and risk of cancer: A matched case-control study. Sleep Med, 2015; 16:1552–1555.
28.
Vezina-ImLA, MorenoJP, NicklasTA, BaranowskiT. Behavioral interventions to promote adequate sleep among women: Protocol for a systematic review and meta-analysis. Syst Rev, 2017; 6:95.
29.
ErrenTC, MorfeldP, FosterRG, ReiterRJ, GrossJV, WestermannIK. Sleep and cancer: Synthesis of experimental data and meta-analyses of cancer incidence among some 1,500,000 study individuals in 13 countries. Chronobiol Int, 2016; 33:325–350.
30.
LuY, TianN, YinJ, ShiY, HuangZ. Association between sleep duration and cancer risk: A meta-analysis of prospective cohort studies. PLoS One, 2013; 8:e74723.
31.
ZhaoH, YinJY, YangWS, et al.Sleep duration and cancer risk: A systematic review and meta-analysis of prospective studies. Asian Pac J Cancer Prev, 2013; 14:7509–7515.
32.
HurleyS, GoldbergD, BernsteinL, ReynoldsP. Sleep duration and cancer risk in women. Cancer Causes Control, 2015; 26:1037–1045.
DeCS, EspirituJR, ZeidlerM, WangTS. Sleep disorders in chronic liver disease. Semin Respir Crit Care Med, 2012; 33:26–35.
35.
MiyakeT, KumagiT, FurukawaS, et al.Short sleep duration reduces the risk of nonalcoholic fatty liver disease onset in men: A community-based longitudinal cohort study. J Gastroenterol, 2015; 50:583–589.
36.
PengK, LinL, WangZ, et al.Short sleep duration and longer daytime napping are associated with nonalcoholic fatty liver disease in Chinese adults. J Diabetes, 2016; 9:827–839.
37.
GarfieldV, LlewellynCH, SteptoeA, KumariM. Investigating the bidirectional associations of adiposity with sleep duration in older adults: The English Longitudinal Study of Ageing (ELSA). Sci Rep, 2017; 7:40250.
38.
SperrySD, ScullyID, GramzowRH, JorgensenRS. Sleep duration and waist circumference in adults: A meta-analysis. Sleep, 2015; 38:1269–1276.
39.
XiaoQ, GuF, CaporasoN, MatthewsCE. Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample. BMC Obes, 2016; 3:48.
40.
AroraT, ChenMZ, CooperAR, AndrewsRC, TaheriS. The impact of sleep debt on excess adiposity and insulin sensitivity in patients with early type 2 diabetes mellitus. J Clin Sleep Med, 2016; 12:673–680.
41.
TaheriS, LinL, AustinD, YoungT, MignotE. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med, 2004; 1:e62.
42.
KooM, LaiNS, ChiangJK. Short duration of sleep is associated with hyperleptinemia in Taiwanese adults. J Clin Sleep Med, 2013; 9:1049–1055.
43.
LiuR, ZeePC, ChervinRD, et al.Short sleep duration is associated with insulin resistance independent of adiposity in Chinese adult twins. Sleep Med, 2011; 12:914–919.
44.
AroraT, JiangCQ, ThomasGN, et al.Self-reported long total sleep duration is associated with metabolic syndrome: The Guangzhou Biobank Cohort Study. Diabetes Care, 2011; 34:2317–2319.
45.
JuSY, ChoiWS. Sleep duration and metabolic syndrome in adult populations: A meta-analysis of observational studies. Nutr Diabetes, 2013; 3:e65.
46.
ZhangR, LahensNF, BallanceHI, HughesME, HogeneschJB. A circadian gene expression atlas in mammals: Implications for biology and medicine. Proc Natl Acad Sci U S A, 2014; 111:16219–16224.
47.
MteyrekA, FilipskiE, GuettierC, OkyarA, LeviF. Clock gene Per2 as a controller of liver carcinogenesis. Oncotarget, 2016; 7:85832–85847.
48.
HuismanSA, OklejewiczM, AhmadiAR, et al.Colorectal liver metastases with a disrupted circadian rhythm phase shift the peripheral clock in liver and kidney. Int J Cancer, 2014; 136:1024–1032.
49.
BlaskDE. Melatonin, sleep disturbance and cancer risk. Sleep Med Rev, 2009; 13:257–264.
50.
ManberR, ArmitageR. Sex, steroids, and sleep: A review. Sleep, 1999; 22:540–555.
51.
El-SeragHB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 2012; 142:1264–1273.
52.
LaposkyAD, VanCE, Diez-RouxAV. Reducing health disparities: The role of sleep deficiency and sleep disorders. Sleep Med, 2016; 18:3–6.
53.
KettnerNM, VoicuH, FinegoldMJ, et al.Circadian homeostasis of liver metabolism suppresses hepatocarcinogenesis. Cancer Cell, 2016; 30:909–924.
